California Approves Drug Formulary
Dec 13, 2017

LEAD STORY

The California Department of Industrial Relations announced the final approval to adopt a drug formulary for the medical treatment of injured workers beginning January 1, 2018. In 2015, the state legislature passed A.B. 1124 to develop and implement a drug formulary for California's workers' compensation program.

 

 

 

 

 

WHAT'S IT DO?

The drug formulary establishes a list of medications appropriate for injured workers, emphasizing their health outcomes and helping them return to work while reducing administrative burdens and costs. The formulary will be part of the Medical Treatment Utilization Schedule (MTUS), which contains guidelines on treatments for injured workers, and is based on medical treatment guidelines created by the American College of Occupational and Environmental Medicine (ACOEM).

 

BENEFITS?

The adoption of a drug formulary addresses the overuse of high-risk medications such as opioids. The California Division of Workers' Compensation (DWC) Administrative Director recognized the national concern regarding the adverse health impacts and other unintended consequences due to opioid misuse and noted that 22,000 deaths involved prescription opioids in 2015. The DWC also noted that the drug formulary is expected to improve patient care and ease approval of appropriate treatment.

 

WHAT ABOUT CURRENT CLAIMANTS?

The rules give doctors until April 1 to develop a treatment plan for weaning claimants who have been taking non-exempt drugs and transitioning them to exempt drugs. If the doctor believes the claimant needs to continue taking non-exempt drugs, then additional reports and documentation justifying why the claimant needs to continue would need to be submitted. The DWC is holding webinars today and tomorrow. We'll keep following as implementation progresses.

California - One More in the Hopper

DEPT. OF INDUSTRIAL RELATIONS

The California Department of Industrial Relations (DIR) announced the insured and self-insured assessments for 2018 and they're going up substantially. The DIR is authorized to assess the costs of the administration of the workers' compensation, health and safety, and labor standards enforcement programs. The six assessment types between insured and self-insured employers have been mailed to insurers and the first installment is due on or before January 1, 2018, with the balance due on or before April 1, 2018.

 

ASSESSMENTS

Insured employers will be paying an assessment of nearly 4% of premium – a 28% overall increase for assessments over 2017. Self-insured employers will pay a 8.01% assessment based on total indemnity benefits paid out to insured workers – a nearly 17% increase over 2017.

Making Our Way Around the Country

TEXAS

The Texas Division of Workers' Compensation announced that it lifted a bulletin, effective January 10, 2018, that tolled (paused) deadlines for workers' compensation procedures in counties impacted by Hurricane Harvey. On that date, all standard workers' compensation deadlines and procedures will go back into effect. The original bulletin required insurance carriers to continue to process and pay workers' compensation claims and pause deadlines for claimants in the counties listed in Gov. Abbott's disaster proclamation.

 

NEVADA

The Nevada Division of Industrial Relations updated its actuarial annuity table effective Dec. 4, 2017 through June 30, 2018. The table is used to calculate lump sum awards for permanent partial disability benefits. The new table increases lump sum payments to injured workers.

 

ALABAMA

Alabamans headed to the polls yesterday and voted for Doug Jones to replace former Senator Jeff Sessions last night. In the special election, Senate Republicans saw their majority holding dwindle to a single seat advantage, giving Democrats more leverage. Alabama has not elected a Democrat to the U.S. Senate since 1992.

 

THE NETWORK

It was nice seeing new and old friends at the National Workers' Compensation & Disability conference last week. We debuted GB's new newsroom - The Network, which can be found on our homepage. You'll now find previous editions of The Way there as well as other original content, what GB supports, GB updates, and where you can find GB at conferences. Check it out and let us know what you think! We'll be adding additional periodicals and content in the coming weeks. Wishing all celebrating a happy Hanukkah!

About The Way

The Way is Gallagher Bassett's weekly governmental briefing on state and federal affairs that affect our industry. We thank you for starting your Wednesday morning with us. Please be sure to follow #GBTheWay for additional news and updates as we make our way throughout the country on the issues affecting our industry. For more information, please connect with GB on LinkedIn, follow us on Twitter, or contact the authors, Greg McKenna or Cari Miller, directly.

Tags:

Share This
Subscribe
 
* Required Fields